Peter Christie

Rapid virological surveillance of community influenza infection in general practice.

The annual outbreak of influenza in Scotland is monitored by sentinel general practices, which report influenza-like illness. We piloted real time virological surveillance to investigate whether polymerase chain reaction (PCR) 1 2 is useful for monitoring an outbreak while it is evolving; to compare PCR with two standard techniques—culture and serology; and to compare two media for submitting samples. Six practices took part. Influenza-like illness was defined by using standard criteria. Combined nose and throat swabs were submitted in both lysis buffer3 and viral transport medium. Two serum samples were taken a minimum of three weeks apart. All samples were posted to the laboratory. Influenza A and B reverse transcription PCR was performed on both media.3 Primary rhesus monkey kidney cells (Biowhittaker, Wokingham) were used to isolate virus. Influenza A and B antibodies were …

The Changing Epidemiology of Bacterial Meningitis and Invasive Non-meningitic Bacterial Disease in Scotland During the Period 1983-99

We reviewed population-based laboratory reports of invasive meningococcal, pneumococcal, Haemophilus influenzae, Group B Streptococcus (GBS) and Listeria monocytogenes isolates in order to examine the changing epidemiology of meningitis and invasive non-meningitic disease (INMD) caused by these 5 pathogens in the 2 periods before (1983-91) and after (1992-99) routine use of H. influenzae type B conjugate vaccine (Hib) in Scotland. Neissieria meningitidis was the most common cause of meningitis, accounting for 39.2% of cases of meningitis in 1983-91 and 47% of cases in 1992-99, followed by H. influenzae (31%), Streptococcus pneumoniae (22.4%), GBS (3.9%) and L. monocytogenes (3.5%) in 1983-91 and S. pneumoniae (36.3%), H. influenzae (7.8%), GBS (6.1%) and L. monocytogenes (2.8%) in 1992-99. The important epidemiological features of meningitis and INMD caused by these 5 pathogens between 1983-91 and 1992-99 include: 1. The incidence of bacterial meningitis due to S. pneumoniae and GBS was stable; 2. S. pneumoniae was the predominant cause of INMD in both periods; 3. The incidences of INMD caused by N. meningitidis, GBS and S. pneumoniae increased, by 27%, 55% and 56%, respectively; 4. Decreases in the incidences of bacterial meningitis (by 50%) and INMD (by 50%) due to L. monocytogenes were detected; and 5. There were dramatic reductions in the proportions of bacterial meningitis (by 92%) and INMD (by 56%) due to H. influenzae in vaccinated and non-vaccinated individuals. Continued surveillance is necessary to monitor the disease trend, population at risk, serotype distribution and antimicrobial susceptibility in order to implement appropriate public health interventions against invasive bacterial disease.

Management of HIV infected health care workers: lessons from three cases.

Three cases in which doctors in Glasgow were diagnosed as having HIV infection were all handled differently in relation to telling patients and the media. In the first patients were not told because the doctor had been doing administrative work and there was thought to be no risk to patients; although the media did report the case, it accepted the assurances given. In the second case, where a doctor had done many jobs in different specialties and places, the media identified the doctor before most patients had been informed: most calls to the helpline subsequently set up by the health authority were from patients who had not been treated by this doctor. This episode, however, allowed the incident team to be prepared for the next case, enabling the helpline to be established swiftly. In this case the doctor voluntarily identified himself, and this served to allay public fears and reduce the number of inappropriate calls to the helpline.

Domiciliary nebulized pentamidine for secondary prophylaxis against Pneumocystis carinii pneumonia.

The viability of a programme for delivering aerosolized pentamidine within the patients home setting for the secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) has been explored with seven homosexual AIDS patients, the major objectives being the assessment of the safety and acceptability of the treatment and the discovery of the most suitable care setting (home, ward, outpatient clinic) for the administration of therapy. It is concluded that a domiciliary prophylaxis programme is a viable alternative.

A Clinical Information System for HIV/AIDS Patients at Ruchill Hospital, Glasgow; Development and Evaluation

One of the most attractive applications of computers in medicine is in improving the quality of clinical casenote recording and use, given the widely acknowledged problems with completeness, accuracy and presentation of information in written casenotes (1, 2, 3, 4). The Clinical Information System (CIS) at Ruchill was developed for use with patients infected with the Human Immunodeficiency Virus (HIV), specifically for use at outpatient consultations. Patients with HIV or AIDS generate an unusually large and complex amount of clinical, social, and laboratory information, and there is also for each patient an idiosyncratic pattern of cross-referral and sharing of care with other medical and social agencies; at a national level there is no system for collection of summary data from outpatient clinics in a manner comparable to the inpatient SMR returns, and this has implications for resource management for a novel and expensive patient group. These two factors potentially make the CIS for this particular patient group a major contribution to quality of care.